Psychometric properties of the modified Suicide Stroop Task (M-SST) in patients with suicide risk and healthy controls.

The Cognitive Model of Suicide proposes a suicide attentional bias in individuals with suicidal thoughts and behavior (STBs). The Suicide Stroop Task (SST) was developed as a behavioral measure to assess this attentional bias. However, prior studies demonstrated poor psychometric properties of the SST. Methods: We developed a modified Suicide Stroop Task (M-SST) and tested its psychometric properties in a sample of healthy controls (n = 30) and inpatients with STBs (n = 24). Participants (50% female, aged 18 to 61 years) completed the M-SST with neutral, positive, negative, suicide-related positive and suicide-related negative words. Interference scores were calculated by subtracting the mean reaction time (mean RT) of the neutral words from the mean RT of the suicide-related positive words (mean RTSuicide-Positive-mean RTNeutral) and suicide-related negative words (mean RTSuicide-Negative-mean RTNeutral), resulting in two suicide-specific interference scores. Similarly, interference scores were calculated for the positive and negative words by subtracting the mean RT of neutral words from the mean RT of positive and negative words. Results: When analyzed separately, patients with STBs showed greater interferences for suicide-related positive words (p = 0.039), and for suicide-related negative words (p = 0.016), however, we found no group differences in interference scores for positive and negative words, suggesting a suicide attentional bias in patients with STBs. Controlling for the repeated measure design, a repeated measure ANOVA failed to detect a significant group × interference interaction effect (p = 0.176), which limits the generalizability of the findings. However, the interference score of suicide-related negative words showed an adequate classification accuracy (AUC = 0.72, 95% CI [0.58-0.86], p = 0.006) for differentiating between healthy controls and patients with STBs. Moreover, the interference scores showed acceptable internal reliability for the total sample and only suicide-related interference scores were correlated with clinical characteristics, thus demonstrating convergent validity. Conclusion: The results provide preliminary evidence for a suicide attentional bias in individuals with STBs compared to healthy controls. The M-SST represents a promising tool for assessing a suicide attentional bias by revealing adequate psychometric properties. Future studies with larger samples are needed to confirm these preliminary findings.

[Utilization of Outpatient Psychotherapy and Outpatient Psychiatric Treatment by Men and Women after Inpatient Treatment due to Suicide Attempt or Acute Suicidal Crisis]. / Inanspruchnahme ambulanter Psychotherapie und ambulanter psychiatrischer Behandlung von Männern und Frauen nach stationärer Behandlung aufgrund eines Suizidversuchs oder akuter suizidaler Krise.

OBJECTIVE: The strongest predictor of suicide attempts is a previous suicide attempt. Individuals hospitalized for suicidal ideation and behavior face an increased risk of suicide following discharge. This study investigates the extent to which outpatient treatment services are utilized the first 6 months after discharge and whether men and women differ in this regard. METHOD: The study examines data of 124 individuals (with suicide attempts (lifetime), 59.7% female) on the use of outpatient treatment services in the 6 months after inpatient treatment. RESULTS: 37.9% (N=47) of individuals reported not having used any treatment services at all. Men were significantly less likely to make use of the services. CONCLUSION: Members of a group with an increased risk of suicide, to a large extent, fail to make use of outpatient treatment services. Discharge management should increasingly focus on (gender-specific) barriers and pave the way for treatment in outpatient.

[COVID-19 Pandemic-Related Effects on Psychiatric and Psychosocial Care in Urban and Rural Areas - Two Studies Implementing the Questionnaire PandA-Psy]. / Corona-Pandemie-bedingte Auswirkungen auf die psychiatrische und psychosoziale Versorgung im städtischen und ländlichen Raum ­ Zwei Untersuchungen mit dem Fragebogen PandA-Psy.

OBJECTIVE: To assess COVID-19 pandemic-related changes in psychiatric and psychosocial services and their impact on the care of people with severe mental illness in two contrasting regions. METHODS: Development and use of an online questionnaire (PandA-Psy) in Leipzig (N=50) and Mecklenburg-Western Pomerania (N=126). RESULTS: In community psychiatric care, mostly comparable changes caused by the COVID-19 pandemic were observed in the two selected regions. These mainly concern the decrease in face-to-face contacts and group services, the increase in digital and telephone services, as well as the increasing constraints of staff. Differences between the regions are discussed. CONCLUSION: PandA-Psy was successfully used to map changes caused by the COVID-19 pandemic in psychiatric and psychosocial services in two areas. In addition to the predominantly negative consequences of the pandemic situation, we also found opportunities arising from the crisis.

[Psychological Burden in Relatives of People with Mental Illness During the COVID-19 Pandemic]. / Psychische Belastungen bei Angehörigen von Menschen mit psychischen Erkrankungen während der COVID-19 Pandemie.

CONCERN: The COVID-19 pandemic is a burden for most people - particular for those with mental illness and their families. The aim of the present study was to investigate specific burdens as well as coping strategies among relatives of people with mental illness. METHODS: A questionnaire to assess Corona pandemic-related influences on burdens of relatives of people with mental illness was developed. A total of 228 relatives participated in the survey between March and June 2021. RESULTS: More than 87% of the relatives surveyed reported that they were burdened by the mental illness of their ill relatives. Many of the respondents subjectively described helpful coping strategies such as appreciation of healthy parts. CONCLUSION: In times of crisis, such as the COVID-19 pandemic, care structures and support services should also be sensitively aligned and continuously provided for relatives of people with mental illness.

[LeiP#netz - Leipziger Psychiatrie Netzwerk - A Pilot Project to Implement the Functional Basic Model by Steinhart and Wienberg in a Defined Psychiatric Care Region]. / LeiP#netz ­ Leipziger Psychiatrie Netzwerk.

BACKGROUND: The functional basic model (Steinhart, Wienberg) offers the theoretic ground for a pilot project which emphasis on outpatient treatment in psychiatric care. METHODS: The following subgoals were pursued a) networking with providers/institutions/actors located in the study region; (b) evaluation of the offered services for the purpose of mapping psychosocial care. Consequently, a project-based survey instrument was developed and applied for the survey of all care providers. RESULT: Merging and networking of all actors was started successfully. All services needed for psychiatric care of severe mentally ill people are provided in the study region. While counselling and prevention tend to be well-maintained structures, there is a lack of access to low-threshold care such as crisis management, retreats alternatives to hospitals and assertive multi-professional complex treatment.

[Psychiatric-Psychotherapeutic Care in Crisis: Results of the LeiP#Netz Pilot Project]. / Psychiatrisch-psychotherapeutische Versorgung in der Krise: Ergebnisse des Pilotprojekts LeiP#netz.

OBJECTIVE: Analysis of psychiatric-psychotherapeutic crisis services in the Leipzig Psychiatry Network (LeiP#netz), assigning the services to the functional areas of the FBM according to Steinhart and Wienberg. METHODS: A standardized survey of crisis care was conducted using the functions "complex outpatient treatment", "access to acute psychotherapy in crisis", and "24 h complex, intensive treatment" by means of facility-related and function-related instruments. RESULTS: A total of 31 measures were recorded for the three functions. All crisis care services were highly utilized; in up to one-third of cases, no services could be provided when demand was requested. Services that do not require registration or offer 24/7 care are available at very low levels. CONCLUSION: Crisis care services for severely mentally ill people are available in various constellations in the study region. Low-threshold 24/7 crisis services need to be expanded.

Global impact of the COVID-19 pandemic on mental health services: A systematic review.

The purpose of the review was to investigate the changes in mental health services during the COVID-19 pandemic. A systematic review of qualitative, quantitative and mixed-methods studies was conducted from February 2021 to March 2022 using four databases and five languages. 29 studies reporting on mental health services in 63 countries were included. Findings were organised according to nine major topics: (1) lack of preparedness vs. timely response and flexible solutions, (2) changes in access, referrals, and admission, (3) impacts on outpatient, community and psychosocial services, (4) inpatient: reorganisation of hospital psychiatric units/acute wards, (5) diagnostic and therapeutic adaptations, (6) effects on medication, (7) infection control measures, (8), changes in patients' demands, engagement, and mental health, and (9) impacts on staff and team. Many services were closed intermittently or considerably reduced while telepsychiatric services were extensively expanded. Face-to-face services decreased, as did the work with therapeutic groups. Many inpatient units restructured their services to accommodate COVID-19 patients. While the digitalisation of services allowed for better access to services for some, restrictive measures hindered access for most. Staff experienced changes such as heightened impacts on their own mental health, burdens on patients and the pausing of professional training. Clearly, diverse findings of studies relate to different (national) contexts, type of service offered, but also to the time of the investigation, as studies noted several distinct phases of change during the pandemic. This review suggests directions for policy and service development, such as fostering community services and providing support services for particularly vulnerable populations.

Heart rate variability in obsessive compulsive disorder in comparison to healthy controls and as predictor of treatment response.

OBJECTIVE: Obsessive compulsive disorder (OCD) has a large impact on the quality of life of patients. It often takes years to get the right diagnosis and to receive treatment. Therefore, biomarkers that could inform the diagnostic process and provide information on response or non-response for first line treatment approaches are urgently needed. The aim of this study was to analyze whether (1) heart rate (HR) and heart rate variability (HRV) markers of the autonomous nervous system could distinguish between healthy controls (HC) and patients suffering from OCD and (2) HRV parameters additionally yield useful information to separate therapy-responders from non-responders. METHODS: A fifteen-minute resting state ECG (electrocardiogram) was recorded from 51 unmedicated OCD patients before treatment and 28 HC. The function of the autonomic nervous system was assessed by using parameters of the HRV. Clinical Global Impression (CGI) scores served as baseline and outcome parameters following three to six months of therapy (cognitive behavioral therapy n = 18, selective-serotonin-reuptake-inhibitor n = 11 or combination n = 22). Differences between patients and HC and responders and non-responders were identified using analysis of covariance (ANCOVAs). Predictive values were calculated following binary regression modelling and receiver operating characteristics (ROC). RESULTS: OCD patients revealed a significantly higher HR in comparison to HC. Although patients were thus characterized by increased sympathetic and decreased parasympathetic tone, treatment responders exhibited a larger High Frequency Power as a marker for increased parasympathetic activity at baseline. ROC-curves for OCD vs HC and R vs NR showed clinically relevant areas under curve (83%, 88% respectively). CONCLUSIONS: These results are in line with findings of increased sympathetic and decreased parasympathetic activity in OCD in comparison to healthy subjects. The findings further provide clinically useful information on treatment response in OCD. SIGNIFICANCE: Results may facilitate the clinical use of electrophysiological markers in OCD.

LeiP#netz 2.0: mapping COVID-19-related changes in mental health services in the German city of Leipzig.

PURPOSE: The purpose of the study was to investigate the changes in psychosocial and psychiatric services in the German city of Leipzig during the COVID-19-pandemic. METHODS: A participatory, mixed-methods study was used involving a quantitative online survey and qualitative semi-structured interviews with professionals. Quantitative findings were reported with descriptive statistics, and thematic analysis was conducted for qualitative data. RESULTS: Fifty professionals from various mental health services participated in the survey and eleven professionals were interviewed. Quantitative findings showed that some services were closed intermittently and that there was a stiff increase in use of digital/telephonic service and a decrease in face-to-face services. Staff or funding did not change considerably during the pandemic. Psychosocial groups were suspended or reduced, while access to services became more difficult and professional training for staff was stopped. Thematic analysis of the interviews showed that professionals experienced different phases and levels of change during the pandemic, including changes on a structural level, on the users' level, and on the staff' level. Professionals particularly criticised the equivocality of COVID-19 regulations, a defective flow of information and lack of attention for mental healthcare in public policies. They also saw positive aspects, such as the capacity of users and the outpatient care system to adapt to the new situation. CONCLUSION: This study suggests directions for policy and service development, such as communicating clearly in infection-control measures, fostering outpatient care and networks between services.

[Psychiatric Emergency Admissions and Inpatient Length of Stay Before and During the COVID-19 Pandemic in Germany]. / Psychiatrische Notfallaufnahmen und stationäre Aufenthaltsdauer vor und während der COVID-19-Pandemie in Deutschland.

OBJECTIVE: The impact of the COVID-19 year on the number of daily psychiatric emergency admissions and length of stay was compared with previous years. METHODS: In a retrospective study, the four quarters of 2020 of several psychiatric hospitals in Germany were statistically compared with the respective quarters of 2018 and 2019. RESULTS: A total of 73,412 cases was analyzed. In the 2nd quarter of 2020, the number of daily admissions was significantly lower as compared to the control period (59.1 vs. 70.7; incidence rate ratio [95 % confidence interval] 0.81 [0.69; 0.96]; p = 0.012). Length of stay was numerically but not significantly different as compared to the control periods. CONCLUSION: The COVID-19 pandemic had a strong impact on inpatient psychiatric care. In the future, multimodal care structures must ensure the care of severely mentally ill people in crisis situations.

[Vocational Perspectives for People with Mental Illness Under Corona Conditions: An Exploratory Brief Survey]. / Arbeitsperspektiven für Menschen mit psychischen Erkrankungen unter Corona-Bedingungen: Eine explorative Kurzumfrage.

OBJECTIVE: Exploratory study of corona-related impacts on vocational perspectives of people with mental illness. METHODS: Short survey with quantitative and qualitative questions among employees from vocational rehabilitation. RESULTS: More than 90 % of the n = 76 participants stated that the situation regarding vocational reintegration or job search had worsened due to corona. Moreover, 75 % considered that there would still be a negative impact on vocational rehabilitation in the longer term. In addition to the main problem of a lack of job offers, open responses on obstacles also referred to increased psychological stress among clients as well as problems in reaching cooperation partners or in dealing with online processes. CONCLUSIONS: Under Corona conditions, the work-related perspectives and participation opportunities of people with mental illness have been additionally worsened.

[Ward-Equivalent Psychiatric Treatment (StäB) for Patients with Severe Obsessive Compulsive Disorder in Times of COVID-19 - A Case Report]. / Stationsäquivalente psychiatrische Behandlung für Patienten mit schweren Zwangserkrankungen in Zeiten von COVID-19 ­ ein Fallbericht.

The ward-equivalent psychiatric treatment (StäB) is an intensive form of treatment and offers patients with severe and/or chronic illnesses the opportunity to take advantage of guideline-oriented treatment.This case description is intended to show the extent to which this form of community-based care - with psychiatric as well as psychotherapeutic treatment in the familiar home context - should be considered as a treatment option for patients with severe obsessive-compulsive disorders, not only in times of the COVID-19-Pandemic.

Leipzig - Individual Placement and Support for people with mental illnesses (LIPSY): study protocol of a randomized controlled trial.

BACKGROUND: Individuals receiving means-tested benefits are at a higher risk of being diagnosed with a psychiatric illness compared to those who are employed, and the rate of those working in the first labor market is low. The intervention (Individual Placement and Support, IPS) aims at maintaining or regaining working ability and at facilitating reintegration into the (first) labor market following a "first place, then train"-approach. The objective of the study is to conduct the first RCT in Germany that addresses a broad group of long-term unemployed individuals with severe mental illnesses that receive means-tested benefits, and to test the effectiveness of the IPS intervention. METHODS: In this randomized controlled trial, about 120 eligible participants aged between 18 years and local retirement age will be randomly allocated to an intervention group (IG) or to an active control group (CG) using a parallel arm design. The IG will receive IPS + high quality treatment as usual (TAU), the active CG will receive TAU + a booklet on integration measures. A block-randomization algorithm with a targeted assignment ratio of 1:1 for participants in IG and active CG will be used, stratified by sex and three age groups. Assessments will take place before the intervention at baseline (t0), and 6 (t1), 12 (t2), and 18 (t3) months later. Primary outcome will be the proportion of participants having worked at least 1 day in competitive employment since baseline, as assessed at t3. Secondary outcomes will be related to employment/ vocation and mental health. In addition, there will be a process evaluation. Treatment effects on outcomes will be tested using appropriate panel-data regression models, and acceptability, uptake and adherence will be evaluated using descriptive statistics and appropriate inference testing. DISCUSSION: The results of this trial are expected to generate a better understanding of the efficiency, feasibility, acceptance, and relevance of the IPS intervention in a German setting. They could be a first step towards the implementation of the method and towards improving the situation of long-term unemployed individuals with severe mental health problems. TRIAL REGISTRATION: German Clinical Trials Register ( DRKS00023245 ), registered on 22.02.2021.

Impact of COVID-19 pandemic on involuntary and urgent inpatient admissions for psychiatric disorders in a German-wide hospital network.

The impact of COVID-19 on urgent and involuntary inpatient admissions, as well as coercive measures, has not been assessed so far. A retrospective study was performed analyzing claims data for inpatient psychiatric admissions between 2018 and 2020 (total n = 64,502) from a large German Hospital network. Whilst the total number of urgent admissions decreased in 2020 (12,383) as compared to 2019 (13,493) and 2018 (13,469), a significant increase in the percentage of urgent admissions was observed in 2020 (62.9%) as compared to 2019 (60.6%) and 2018 (59.7%). Compared to this study period, Odds ratio (OR) for proportion were 0.87 (0.84, 0.91) and 0.91 (0.87, 0.95) for 2018 and 2019, respectively (both p < 0.00001). Percentage of involuntary psychiatric admissions also significantly increased in 2020 and OR compared to this study period ranged from 0.86 (0.81, 0.93) in 2019 (p < 0.0001) to 0.88 (0.82, 0.95) in 2018 (p < 0.001). Proportion of coercive measures significantly increased in 2020 as compared to 2019 (p = 0.004). Taken together, the present study shows an increase in the proportion of involuntary and urgent psychiatric admissions during the whole pandemic year 2020 as compared to 2018 and 2019. The long-term impact of these COVID-19 pandemic-related trends on psychiatric health care needs to be assessed in further studies.

Child abuse and suicidality in the context of the Interpersonal Psychological Theory of Suicide: A network analysis.

OBJECTIVES: While there is evidence for an association of child abuse with suicidality in the course of life, the underlying mechanisms remain unclear. The Interpersonal Psychological Theory of Suicide (IPTS) provides a theoretical framework to investigate this relationship. The present study examines how different subtypes of child abuse are related to suicidal ideation and to attempts in the context of the IPTS. METHODS: 146 psychiatric inpatients (M = 37.9 years, 62% female) with an acute suicidal crisis (n = 71) or a recent suicide attempt (n = 74) were examined at baseline (T0) and six (T1) months later. We measured emotional, physical, and sexual abuse, the constructs of the IPTS (thwarted belongingness, perceived burdensomeness, and capability for suicide) and suicidal ideation as well as suicide attempts. Using the statistics program R, a network analysis of all named constructs was conducted. Centrality measures were computed. RESULTS: Emotional abuse was the most central kind of abuse in the network and had a direct relationship with suicide attempts and an indirect relationship with suicidal ideation via perceived burdensomeness. Physical and sexual abuse showed no significant relations with the different constructs of the IPTS. CONCLUSION: The major limitation of this study was the modest sample size which reduced the number of variables able to be included in the network. Regarding child abuse, the results underline that emotional abuse plays a central role in this network and may be important for suicide risk assessment. Future research should address this topic in a larger sample. PRACTITIONER POINTS: Emotional abuse was the most central kind of abuse in this network analysis. Sexual abuse was the only kind of abuse with a direct relation to suicidal ideation. Capability for suicide had just a marginal position in the network analysis. Early interventions addressing the effects of child abuse are recommended. Replications in larger samples and with more relevant variables are needed.

Emergency hospital admissions for psychiatric disorders in a German-wide hospital network during the COVID-19 outbreak.

PURPOSE: Psychiatric emergency hospital admissions for distinct psychiatric disorders and length of inpatient stay in the hospital during the Coronavirus disease 2019 (COVID-19) outbreak have not been thoroughly assessed. METHODS: A retrospective study was performed analyzing claims data from a large German Hospital network during the COVID-19 outbreak (study period: March 13-May 21, 2020) as compared to periods directly before the outbreak (same year control: January 1-March 12, 2020) and one year earlier (previous year control: March 13-May 21, 2019). RESULTS: A total of 13,151 emergency hospital admissions for psychiatric diagnoses were included in the analysis. For all psychiatric diagnoses combined, emergency admissions significantly decreased during the study period with mean (interquartile range) incidence rate ratios (IRRs) of 0.68 (0.65, 0.71) and 0.70 (0.67, 0.73) as compared to the same and previous year controls, respectively (both p < 0.00001). IRR ranged from 0.56 for mood affective disorders (F30-F39) to 0.75 for mental disorders due to psychoactive substance use (F10-F19; all p < 0.00001). Mean (standard deviation) length of hospital stay for all psychiatric diagnoses was significantly shorter during the study period [9.8 (11.6) days] as compared to same [14.7 (18.7) days] and previous [16.4 (23.9) days] year controls (both p < 0.00001). CONCLUSION: Both emergency hospital admissions and length of hospital stay significantly decreased for psychiatric disorders during the COVID-19 outbreak. It needs to be assessed in further studies whether healthcare systems will face increased demand for the provision of mental health care in the nearer future.

[COVID-19 Pandemic and Psychiatry - How much have the Interests of People with Psychiatric Disorders been Considered in German Laws?] / COVID-19-Pandemie und Versorgung schwer psychisch erkrankter Menschen ­ Inwieweit wurden die Interessen psychisch erkrankter Menschen in den Schutzverordnungen des Bundes und der Länder berücksichtigt?

OBJECTIVE: Official regulations during the first COVID-19 lockdown in Germany were analyzed concerning their impact on patients with psychiatric disorders. METHODS: All regulations valid between March 1, 2020 and June 30, 2020 with a link to health were included in the analysis. RESULTS: A total of 344 regulations was identified. Psychiatric health care structures were severely limited with significant heterogeneity concerning extent and duration between the different Federal states. In four Federal states, psychiatric hospitals were exempted from providing capacities towards intensive care. Three Federal states loosened visiting limitations for psychiatric patients. CONCLUSION: During the first lockdown, a broad range of regulations concerning the health care system was adopted often without specifically addressing psychiatric disorders. In the future, the needs of psychiatric patients have to be considered more thoroughly.

Treatment Goals for Patients with Schizophrenia - A Narrative Review of Physician and Patient Perspectives.

INTRODUCTION: There are many possible treatment goals for patients with schizophrenia. Two major perspectives on treatment goals are the patient's and the physician's perspective. Patient-centered treatment mandates that an individual patient's treatment goals are taken into account when treatment is planned. In this narrative review, we address the commonalities and differences of the patient's and physician's perspectives. METHODS: We searched for literature on treatment goals for patients with schizophrenia from the last 10 years. RESULTS: Fifty-two relevant records were identified, 4 of which directly compare patient's and physician's perspectives. Two further articles used the same set of goals to ask patients or physicians for their assessment. DISCUSSION: Agreement between patients and physicians regarding valuation of treatment goals was high. However, physicians tended to put more emphasis on the classical "textbook" goals of symptom resolution and functioning, while patients stressed well-being and quality of life more. Results on treatment goals from patients are difficult to generalize, since recruiting representative patient samples is challenging and patient subgroups may have differing priorities.

Is the relationship between child abuse and suicide attempts mediated by nonsuicidal self-injury and pain tolerance?

Although there is evidence for an association of child abuse with lifetime suicidal behaviour, the underlying mechanisms remain unclear. In recent research, we found this relationship to be indirect and mediated by capability for suicide (CS). Emotional and sexual abuse were directly associated with CS. Based on the Interpersonal Psychological Theory of Suicide, the result for emotional abuse was surprising and raised the question for a missing link in this association. Consequently, this study examines nonsuicidal self-injury (NSSI) as an additional mediator (M1 ) between child abuse (X), pain tolerance (M2 ), and suicide attempts (Y). We included 308 psychiatric inpatients (M = 36.9 years, 53% female) with either an acute suicidal crisis (n = 146) or a recent suicide attempt (n = 157). For the assessment, we used the Childhood Trauma Screener (CTS), the German version of the self-injurious thoughts and behaviours interview (SITBI-G), the German Capability for Suicide Questionnaire (GCSQ), and a pressure algometer for measuring pain tolerance objectively. Serial mediator analyses were applied. All types of abuse showed relationships with NSSI, which itself was connected to suicidal behaviour in almost all models, whereas pain tolerance did not show the expected relations. The results suggest that NSSI is an important predictor for suicide attempts and should be considered in suicide risk assessment. Future research should address this topic in prospective studies with a more comprehensive assessment of child abuse. In summary, this study once again highlights the serious effects of child abuse and in particular the mediating role of NSSI.